Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands.
Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Center, Location VUMC, Amsterdam, The Netherlands.
Kidney Int. 2019 Aug;96(2):283-286. doi: 10.1016/j.kint.2019.03.032.
The first cardiovascular (CV) safety trial conducted with a sodium-glucose cotransporter (SGLT)-2 inhibitor, Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME), reported not only remarkable risk reductions in CV outcome, but also impressive improvements in renal outcome. Changes in renal hemodynamics could be involved in the benefit of SGLT2 inhibitors on renal outcomes. Considering that all patients of EMPA-REG OUTCOME had established atherosclerotic CV disease at baseline, many patients were also treated with several CV drugs at baseline, including RAS blockers, diuretics, calcium-channel blockers, and nonsteroidal anti-inflammatory drugs. These drugs also impact renal physiology and possibly renal outcome, which could cause relevant drug-drug interactions. This topic is addressed in this issue of Kidney International by Mayer and colleagues. In their manuscript, the impact of empagliflozin on kidney function, renal outcome, and renal safety is presented with stratification for background therapy. Although the beneficial effects of empagliflozin and its safety profile are consistent among all groups, we wonder, do we really understand the renal effects of all these drugs in type 2 diabetes (T2D) patients as studied in the large outcome trials?
首项钠-葡萄糖共转运蛋白 2（SGLT-2）抑制剂心血管（CV）安全性临床试验，即在 2 型糖尿病患者中评估恩格列净心血管结局（EMPA-REG OUTCOME）试验：降低血糖，除了显著降低 CV 结局风险，还可明显改善肾脏结局。肾脏血流动力学的改变可能与 SGLT2 抑制剂对肾脏结局的获益相关。考虑到 EMPA-REG OUTCOME 所有患者在基线时均患有动脉粥样硬化性 CV 疾病，许多患者在基线时还接受了多种 CV 药物治疗，包括 RAS 阻滞剂、利尿剂、钙通道阻滞剂和非甾体抗炎药。这些药物也会影响肾脏生理学，可能影响肾脏结局，从而导致相关的药物相互作用。本期《国际肾脏》杂志由 Mayer 及其同事探讨了这一话题。在他们的论文中，根据背景治疗进行分层，呈现了恩格列净对肾功能、肾脏结局和肾脏安全性的影响。虽然在所有组中，恩格列净的有益作用及其安全性特征一致，但我们不禁要问，在大型结局试验中，我们是否真的了解这些药物在 2 型糖尿病（T2D）患者中的肾脏作用？
